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Board and Care Homes for Seniors

Most elderly people find that their needs fall beneath having daily skilled nursing services.  They don't need to be housed in a nursing home.  The small residential care home, licensed for 2 to 6 people provides a safe, comfortable and dignified environment for those who need help intermittently throughout the day and night. Source: California Registry
In This Article:
What is a Board and Care Home?Board and Care Home: how is it different?Candidates for Board and Care HomesWhat is the living arrangement?Board and Care Home: services providedCost of a Board and Care HomeFinding an appropriate facilityReferences and links
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What is a Board and Care Home?
A Board and Care Home is a housing facility for seniors or for individuals with disabilities who want or need to be in a group living situation and who may need assistance with personal care and daily living activities.  Typically, a Board and Care facility is selected when 24-hour, non-medical supervision is needed or desired. Board and Care homes were the first widely recognized form of assisted living, and as such, they have been regulated by government agencies; but many Board and Care homes are of the “mom and pop” variety and not licensed.  Thus, if a Board and Care home is under consideration, licensure status should be verified with a county or state licensing office.  Board and Care homes can be a converted single-family home with up to 6 residents or may be a large building similar to an apartment building with over 100 residents.  A characteristic feature of Board and Care is that communal meals are provided, and there is daily contact with staff.  In various parts of the world, you will find many other names for Board and Care Homes such as:
Adult Foster Care Homes Residential Care Facilities Retirement HomesAssisted Living FacilitiesAdult Care Homes Personal Care Operations Sheltered Care Homes Independent Living Facilities Domiciliary Care
An example of varied names for Board and Care comes from the state of Washington where a facility for 6 individuals or less is called an “Adult Family Home” while facilities licensed for between 7 and 150 residents are called “Boarding Homes.”  While many Board and Care Homes are for seniors, some specialize in the care of younger people, or people with special needs.  Depending upon licensing, a Board and Care Home might serve only elderly, or people with disabilities or chronic psychiatric problems, or Alzheimer’s patients.
How is a Board and Care Home different from Assisted Living Facilities or a Nursing Home?
With the proliferation of housing-with-services in recent decades, many types of assisted living facilities have opened, providing a wide range of services.  So long as a person does not need daily services of medical professionals, an assisted living facility may be available that helps with most every aspect of personal care such as dressing, grooming, eating, toileting and getting around.  In the days when most seniors had to go to a nursing home if they needed such comprehensive custodial care, the Board and Care homes provided minimal assistance.  The larger facilities were often called “retirement homes,” and required that the senior be capable of getting to the dining hall for meals, and be independent in most activities.  The staff might monitor the resident’s medications to be sure they were taken on time in the right dosages.  Housekeeping and laundry were commonly provided by the staff.  The typical large Board and Care home offered little else in the way of personal assistance.  The smaller 2-6 bed facilities often did a lot more for the residents, such as assistance with dressing, toileting and getting around.  Many of these had special licenses qualifying them to perform those extra personal services.
Nowadays, even though Board and Care is just one type of assisted living, it is a very important type.  Because of their history, Board and Care facilities are subject to state licensing laws, so can be held to recognized standards of care, and if there are problems such as inadequate care, the facility can be reported to the government body that regulates it.  In addition, government funding sometimes can cover the cost of living in a Board and Care, for people receiving public assistance payments (SSI).  For details, see Payment Options for Senior Housing and Residential Care. 
It’s important to remember that “mom and pop” Board and Cares, and other types of assisted living facilities, are not always closely regulated.  Because of this, standards of care are not uniform, and services vary greatly from one facility to the next.  If you are looking for an assisted living arrangement, it’s important to ask about each facility’s certifications and licenses, then check their validity.  A government-backed licensing program is likely to be more specific in standards of care than a commercial company who does certification.  Even with licensing, though, government agencies may only infrequently monitor facilities, so it’s important to drop in unannounced to confirm that conditions are safe and sanitary, that promised services are being provided, and that no elder abuse or neglect is occurring.
A Board and Care Home differs from a Nursing Home in that it has very limited, if any, onsite medical care.  A Nursing Home is for people who require daily supervision and care provided by medical professionals such as registered nurses and certified nurse assistants, under the supervision of licensed physicians.
Good candidates for Board and Care Home
Board and Care Homes can serve the needs of a variety of senior citizens:
Seniors who are becoming frail, and find the responsibilities of homemaking an increasing burden, or too difficult to do consistently.Seniors with chronic illnesses who need daily assistance with cooking, cleaning, and monitoring medications.Seniors with very limited income and assets who are having difficulty paying for rent, food and household expenses can have a room and meals paid by public assistance--their SSI benefits.
The staff at a Board and Care Home encourages residents to be as independent as they can safely be, making as many choices as possible about their daily lives and health care.
Living arrangements in a Board and Care Home
Residents of a Board and Care Home have a private or shared room and may have private or shared bathrooms.  The rooms usually do not include a kitchen, since providing meals is a major function of the facility.  Facilities generally have some common areas for socializing which include a dining area and one or more other rooms that are mainly for informal contact. 
The larger facilities will often have other rooms that might be used for classes, concerts, lectures, films, games, or exercise programs.  Sometimes outdoor areas are also available with some amenities such as swimming pool, shuffleboard or Jacuzzi.
Services provided in Board and Care Homes
A Board and Care Home provides the following services:
A basic room for sleeping that might include a desk, chair with reading lamp, or TV.  (For low-cost units the room may be shared.) Meals Help with daily activities, such as money management and setting up health care and other appointments Custodial help: reminding, laundry, housekeeping, transportation Reminders to take medications Daily contact with staff (supervision) 
Additional services that a Board and Care may provide (depending upon the facility’s specialty and licensing):
Assisted living, such as bathing or grooming Dispensing of medications Social, recreational, and spiritual activities
Cost of a Board and Care Home
A Board and Care Home can cost from $350 to $3500 per month, depending on its location, the size of the living space, the amount of privacy, and the amenities provided.
Finding an appropriate facility
The References section below has examples of several ways to locate facilities primarily through government agencies or non-profit organizations.  There are also private housing and care referral and placement services that can help older adults and families find a facility that is a “ best fit”.  Recommendations are based on information about the seniors’ physical, mental and cognitive condition, their financial situation, location and other personal preferences.  Fees for this type of service are generally paid by the facilities so some checking is recommended, such as asking for references. 
To learn more: Related Helpguide Articles
Helpguide’s series on Senior Housing & Care
Choosing Senior Housing and Residential CareIndependent Living for Seniors: A Retirement Community of PeersAssisted Living Facilities for SeniorsBoard and Care Homes for SeniorsNursing Homes (Skilled Nursing Facilities)Continuing Care Retirement Communities (CCRCs)Congregate Housing for SeniorsHospice Care: Full Service Support at Home or in a FacilityAdult Day Care Centers: A Guide to Options and Selecting the Best CenterServices to Help Seniors Stay At Home
References and resources for Board and Care Homes
Eldercare Locator – A government-sponsored website for finding a range of senior services in your area, including licensed residential care, also available by calling an information specialist at (800) 667-1116. (U.S. Dept. of Health and Human Services)
How to pick the right assisted living facility – A comprehensive overview includes a 2-page checklist for evaluating facilities you are considering.  (Yale-New Haven Hospital)
Board and Care Home Checklist (PDF) – Allows for easy comparison of Board and Care Homes based on services, staff, physical environment, credentials, costs, and overall quality. (
Choosing Care in an Adult Family Home or Boarding Home – A 20-page brochure in large print, .PDF format that has general guidelines for determining the elder’s needs, finding Board and Care homes to visit and assessing them. (Washington Aging and Disability Services Administration)
What To Look For When Choosing an Assisted Living Facility – Discusses types of facilities, issues of moving from a private home to a facility and a checklist for comparing assisted living facilities.  Board and Care homes are called “Adult Care Homes” in this article.  (Full Circle of Care, North Carolina)
The Transition Toward Living With Assistance – A brief article with tips and guidelines for discussing assisted living with your loved one as well as the steps needed to initiate the change. (
Doug Russell, L.C.S.W., and Monika White Ph.D., contributed to this article. Last modified: February 07.

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